State Guide

Credentialing in Virginia

Enrollment guides for 55 payers operating in Virginia.

What actually differs in Virginia

Credentialing advice written for "most states" tends to be wrong here in specific, expensive ways. These are the rules that only apply in Virginia.

3 sourced rules, each linked to its source

Getting enrolled 1 Who on your team can bill 1 Licensing and prescribing 1

3 sourced rules

Every claim on this page links to the statute, rule or agency page it came from. Last checked July 2026.

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Rendering-NPI billing + PRSS enrollment (2025) DMAS bulletin 2025-06-23

Effective July 1, 2025, DMAS requires services to be billed as rendered, under the rendering provider's NPI, and prohibits MCOs and DMAS from paying claims to network providers not enrolled in PRSS under the correct provider type and specialty. The same bulletin killed the historic 90-day grace period after license expiration. From July 1, 2025 a lapsed license means enrollment terminates without grace, and reinstatement is dated to the month of re-application.

DMAS Updated Provider Enrollment Requirements bulletin via kb/states/va.md · checked Jul 2026

Residents and supervisees (first-class renderers, Pattern A) VA SPA 24-005; 12VAC30-50-226

Virginia's pre-licensed tier, LMHP-R (Resident in Counseling), LMHP-RP (Resident in Psychology), LMHP-S (Supervisee in Social Work), enrolls with DMAS as individual provider types and bills under their OWN NPI, with state-plan authority in SPA 24-005 ('Other Licensed Practitioners', effective January 1, 2024) listing them as individual provider types that bill DMAS independently, not through a facility or group. The supervision rail: sessions must be under direct personal supervision of a licensed, Medicaid-enrolled provider, and the note needs the supervisor's dated co-signature within ONE business day of the service.

VA SPA 24-005 Other Licensed Practitioners via kb/states/va.md · checked Jul 2026

State controlled-substance registration Va. Code § 54.1-3422

Virginia requires no state CSR for individual prescribers, Va. Code § 54.1-3422 exempts MDs, DOs, NPs, PAs and dentists, so DEA plus the Virginia license suffices. But the practice-ENTITY CSR still applies to clinics that stock or dispense medications, the entity registration catches med-stocking practices.

Va. Code § 54.1-3422 (official code, cited as primary in kb/states/va.md) · checked Jul 2026

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Who Runs Virginia Medicaid Provider Enrollment

50-state research

Enrollment Portal

MES provider portal

Operated By

Gainwell Technologies

Platform

MES

Virginia moved provider enrollment from Conduent to Gainwell under the Medicaid Enterprise System program, so older instructions may reference the retired portal.

Go to the official Virginia enrollment portal

From PayerReady's 50-state Medicaid enrollment platform research, verified July 2026. Portal contracts change; where an operator is in transition or not publicly confirmed, we say so rather than guess.

Aetna

Aetna (CVS Health)

Commercial

Network: Open

Timeline: 90-150 days

CAQH Required

Credentialing in Virginia

What actually differs in Virginia

Who Runs Virginia Medicaid Provider Enrollment

Aetna

UnitedHealthcare

Cigna Healthcare

Anthem / Elevance Health

Humana

Centene Corporation

Molina Healthcare

Kaiser Permanente

CareFirst BlueCross BlueShield

Anthem Blue Cross and Blue Shield of Virginia

Virginia Medicaid

UnitedHealthcare Community Plan

Amerigroup (Anthem)

Aetna Better Health

Molina Healthcare (Medicaid)

Anthem HealthKeepers / Hoosier Healthwise

TRICARE

TRICARE East Region (Humana Military)

CHAMPVA

Delta Dental

Cigna Dental

MetLife Dental

Guardian Dental

Aetna Dental

United Concordia

DentaQuest

MCNA Dental

Liberty Dental Plan

Dental Network of America

VSP Vision Care

EyeMed Vision Care

Davis Vision

Spectera / UHC Vision

Optum Behavioral Health

Carelon Behavioral Health

Magellan Health

Evernorth Behavioral Health

Workers' Compensation

Palmetto GBA (Jurisdiction J/M)

CGS Administrators (DME B/C)

Ambetter

Amerigroup (Wellpoint)

Anthem Blue Shield

Blue Cross Blue Shield

Carelon

Centene Corporation

Community Plan

Compsych

Kaiser Permanente Health Plans

Medicaid

Medicare

Medicare Fee-for-Service (CMS)

Megellan

MultiPlan

WellCare

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